Utilization Management Representative (UMR)

?? Pearland, TX (Onsite – 11511 Shadow Creek Parkway)
?? Full-Time | 24–40 hours/week | Monday–Friday, 8:00 AM – 5:00 PM

Why This Role Matters

Join a mission-driven healthcare team where your work directly impacts patient care, provider experience, and operational excellence. As a Utilization Management Representative, you’ll play a vital role in ensuring patients receive the right care at the right time—while helping providers navigate the authorization process efficiently and accurately.

This is an opportunity to grow your career in healthcare operations while working alongside clinical professionals in a highly collaborative, fast-paced environment.

What You’ll Do

• Serve as a key point of contact for providers, members, and facilities—delivering timely, professional support on authorization requests and coverage inquiries

• Drive efficient intake and processing of authorization requests via phone, fax, and electronic systems

• Ensure accurate and compliant documentation within utilization management and electronic health record systems

• Partner closely with clinical reviewers (RNs, LVNs, Medical Directors) to route cases requiring medical necessity review

• Communicate authorization decisions clearly and compliantly to providers and members

• Maintain high productivity and quality standards in a fast-paced, high-volume environment

• Identify opportunities to improve workflows, enhance provider experience, and support operational excellence

What You’ll Bring

• 1–3 years of experience in healthcare operations, utilization management, insurance, or medical office settings

• Proven ability to manage high call volumes with professionalism and efficiency

• Strong attention to detail with accurate data entry and documentation skills

• Experience working with EMR/EHR or case management systems

• Solid understanding of healthcare authorization processes (preferred)

• Excellent communication skills and the ability to collaborate across teams

• Strong organizational and multitasking abilities in a deadline-driven environment

What Sets You Apart

• Experience supporting prior authorizations or working within managed care environments

• Ability to thrive in a production-driven setting while maintaining quality and compliance

• A proactive mindset with a focus on continuous improvement and teamwork

Your Team & Culture

You’ll be part of a high-performing Utilization Management team of ~20 professionals, working alongside clinical experts including RNs, LVNs, and Medical Directors.

Our culture is built on:

• Collaboration – We support each other and work as one team

• Accountability – We take pride in delivering quality and results

• Growth – We encourage learning and continuous improvement

• Purpose – Everything we do supports better patient outcomes

What You’ll Get

• Competitive pay (weekly pay structure available)

• Consistent weekday schedule – no nights

• Opportunity to work closely with clinical leadership

• Career growth within healthcare operations and managed care

• Supportive, team-oriented environment

Interview Process

• Virtual interview process (video)

• Streamlined and efficient hiring experience